The results, published as the 2002 Community Assessment of Needs on the Southern Kenai Peninsula, included responses from more than 50 representatives of local service providers - law enforcement agencies, physicians, schools, churches, and employees and consumers of mental health services, among others.
The survey began by presenting participants with an open-ended question asking them to identify the most pressing problems in the community.
The most common answer, given by 12.4 percent of participants, was drug and alcohol abuse by adults.
Although the range of responses varied between concerns about the economy to access to public facilities, the second-most common response - drug and alcohol abuse by youth - almost mirrored the first.
Other top problems identified by participants were concerns about families and youth, and alcohol abuse is so closely tied to those issues that the community would do well to look at those separate problems as part of a larger one, said Kemper Breeding, the executive director at the Community Mental Health Center.
"It's known that individuals who use, abuse alcohol do things that they normally wouldn't do," said Breeding.
Their inhibitions are lowered, leading to impulsive behavior that can include hostile and abusive behavior in the home, he said.
"I'm not saying that everyone who drinks is an abuser. But it's frequent that many who abuse - spousal abuse, child abuse, sexual abuse or rape - are under the influence of alcohol when they do it," he said.
The survey, completed by a consultant with assistance from the Community Mental Health Center staff, notes a strong link between alcohol use and family and children issues: "Certainly substance abuse is not the only source of family and child/adolescent concerns. But in Homer, and in many other Alaska communities, substance abuse is so far out in front that all others pale in comparison," it reads.
Alcohol abuse vs. use
Definitions of alcohol abuse, and explanations of the difference between it and alcohol use, vary.
People who lose control of their actions when they drink but continue to drink anyway are straddling the line between use and abuse, said Henry Novak, executive director of the Cook Inlet Council on Alcohol and Drug Abuse, a private nonprofit organization that provides outpatient treatment on the Kenai Peninsula. CICADA has offices in Kenai and Homer.
"Some drink more than is healthy, but hold jobs," he said. Then, there are those who crack the bottle and can't guess where the night is going to take them, who give control over their actions to alcohol, he said.
Many people, young and old, use alcohol fairly innocently, he said.
"It's a good way of medicating stress - it medicates emotions. And it's kind of a social lubricant," Novak said.
When a person begins to drink to avoid stressful situations, then that person is in danger of crossing the line from use to abuse. Taking "time off" from life doesn't allow an individual the chance to develop everyday coping mechanisms. Alcohol and other drugs interfere with the normal process of growing up and dealing with adversity without the help of chemicals, Novak said.
"That's why you sometimes could see a 45-year-old person reacting like a 15-year-old. Because that's when they stopped learning how to deal with stressful situations in a constructive manner," he said.
Peg Coleman, the executive director at South Peninsula Women's Services, works with families who have a history of physical abuse, which is statistically tied to substance abuse, she said.
She sees the threshold between use and abuse as existing when someone realizes that they lose control when they drink. Blackouts or unexpected physical violence resulting from drinking are clues.
Alcohol leads to crowded courtrooms
The numbers tell quite a story of alcohol use across the country. A two-year study released in 1999 by the Center on Addiction and Substance Abuse at Columbia University estimated that parental substance abuse and addiction costs the nation some $20 billion a year - half in child welfare system costs, and half in lost productivity and health care, law enforcement, criminal justice, family courts, welfare and social service costs.
The list of court case numbers at the Homer Courthouse offers a small perspective on the amount of time taken by alcohol-related issues locally.
Twelve of the 30 cases filed last month included charges that a driver was under the influence.
Still, the numbers don't tell the whole story, said District Court Judge Francis Neville, who retired from the bench in October.
Neville said she believes that the true effects of alcohol and alcohol abuse on the court system's calendar are extremely hard to identify. Alcohol plays a hand in a great number and variety of criminal cases, from domestic violence to burglary and juvenile crime, she said.
However, alcohol often is not identified as a primary factor in those criminal cases. Nevertheless, it is often there, pulling strings behind the curtains.
"You don't see it on the face of the file," she said.
The effects spill into civil court as well, she said, as alcohol abuse has a hand in a number of divorces and child custody cases.
Until courts and the state find a way of getting alcohol abusers into and through treatment, repeat offenders will continue to take up much of Alaska courts' time and resources, Neville said.
"It would be really nice if people could be stopped at that first DUI, and we were not dealing with those second and third offenders," she said.
Fetal Alcohol Syndrome
One of the most pronounced and long-lasting medical conditions caused by alcohol results when pregnant mothers drink.
Fetal Alcohol Syndrome (FAS) and related disorders such as Fetal Alcohol Effects (FAE) are leading preventable causes of mental retardation and birth defects.
The national Centers for Disease Control and Prevention in Atlanta describes FAS as characterized by abnormal physical features, growth deficiencies and central nervous system malfunctions.
"People with FAS may have problems with learning, memory, attention span, communication, vision, and/or hearing," the center's Web site explains.
In addition, some children may have some, but not all, of the clinical signs of FAS and fall into subcategories in which children have diagnostic features of FAS but at mild or less severe levels.
The disorders are 100 percent avoidable, said Diane Casto, program manager for the state's Office of Fetal Alcohol Syndrome, part of the Department of Health and Social Services.
"If a mother does not drink during pregnancy, there will not be any FAS births. Period," Casto said.
Still, approximately 15 Alaska infants are born with FAS every year, according to the Office of FAS. Another 148 are identified as being affected by maternal alcohol use during pregnancy.
The numbers might not seem overwhelming at first, but when viewed cumulatively they become significant, said Susan Merrick, a project coordinator with Alaska's FAS Surveillance Project, part of the Office of FAS.
"What people don't realize is that number occurs year after year after year," said Merrick.
Although not documented, using the numbers above one could estimate that more than 6,500 Alaskans under the age of 45 could be living with a disability as a result of prenatal alcohol exposure.
If the disorder goes undiagnosed it can cause serious difficulties for children and young adults, particularly in school, Casto said. The transition from elementary school to middle school, when students must begin to juggle a class schedule between different classrooms, can be particularly difficult, she said. Simple tasks like linking a class with an assigned room and teacher can be too much for a child with an FAS-related disorder.
"I've heard a young woman (with FAS) say that she knows the information is in her brain, but it's like a little man is running around in her brain trying to find it," she said. "And I think this happens a lot with this disability."
The disorder can cause frustration and an inability by those affected to understand what is wrong if continuously left undiagnosed. That frustration can accumulate over years, leading, ironically, to a relatively high chance that someone with FAS or a related disorder will begin using alcohol as a way of self-medicating, Casto said.
The high rate of FAS corresponds to the high rate of alcohol abuse in Alaska. A collaborative study between the Centers for Disease Control and Prevention and five states - Alaska, New York, Wisconsin, Arizona, and Colorado - showed that Alaska had the highest prevalence of FAS births at .15 percent, or 1.5 out of every 1,000 live births - almost four times the rate of New York, the second highest.
Alaska Natives, with 5.6 FAS births for every 1,000, were the group with the highest incidence of FAS in the study.
Alcohol and health care
Emergency room and hospital staff often find themselves treating people for alcohol-related injuries or illnesses. Some might be cases of chronic alcoholics with failing health, while others injured themselves while drinking.
Hal Smith, an emergency room physician since 1982, estimates that about one out of three emergency room visits is an alcohol-related injury, and says the basic procedures that accompany an emergency room visit are complicated when alcohol is involved in large doses.
Alcohol acts as an anesthetic or painkiller, and when dealing with a patient who is heavily under the influence, it is tougher for hospital staff to make an immediate diagnosis.
Alcoholics also have a tougher time making the cognitive decision to give control to health care professionals, Smith said, and they often are difficult to treat. They need to be reassured or convinced, sometimes continuously, that the help available is good for them, before consenting.
The time and money lost by emergency room staff in treating alcohol-related injuries and illnesses may not be included in government or medical studies.
A study prepared for the Alaska Department of Health and Social Services concluded that health care costs resulting from alcohol and drug abuse were $123 million in 1999.
The study also estimated there were 24,666 hospital care days related to alcohol abuse that year - 10 times the number of days resulting from other drug abuse.
Novak said the numbers of alcohol-related illnesses counted in such studies, while high, are still ineffective indicators of the true costs of substance abuse on society's health.
Many medical problems are the result of alcohol abusers' bodies breaking down over the years.
The effects of chronic alcohol abuse hits friends and families as well, Novak said.
"There's such a loss of life and loss of quality of life from alcoholism," he said.
Chris Eshleman can be reached at chris.eshleman@homernews.com.
We encourage you to add your comments. To prevent spam, comments with links are manually approved during the normal business day. Please be respectful of others with your comments, bear in mind anyone in the community may be reading your comments.
